Managing Complications and Side Effects
The build-up of myeloma cells in the bone marrow can lead to a number of medical problems that need to be identified, monitored and treated.
Throughout our lives, our bones are constantly being remodeled by two types of cells with complementary functions:
- Osteoclasts break down old bone to make room for new bone.
- Osteoblasts lay down new bone to replace the bone broken down by osteoclasts.
Under normal conditions, both types of cells keep the rate of bone formation and bone breakdown equal, so that bone mass remains the same.
Myeloma cells stimulate the osteoclasts (the cells that break down bone) while at the same time interfering with the production of osteoblasts (the bone-forming cells).
As a result, bone is broken down faster than it can be replaced, leading to:
- Areas of damage (or "holes") in the bone (i.e., osteolytic or lytic lesions).
- Progressive thinning of the bones (i.e., osteoporosis).
|How do bone complications affect you?||How are they managed?|
Increased risk of fractures
Is exercise safe?
Unless there are reasons not to exercise, mild or moderate activity, such as walking or swimming, may be physically and emotionally beneficial. Avoid contact sports or activities that could result in falls. Ask a physical therapist or your healthcare team to suggest activities that are appropriate for you.
The high number of myolema cells crowds out red blood cells and decreases their production in the bone marrow, leading to a reduced red blood cell count. Red blood cells contain hemoglobin that carries oxygen from the lungs to cells throughout the body, providing stamina and energy. A low hemoglobin count can lead to anemia.
|How does anemia affect you?||How is it managed?|
Shortness of breath
Why treat anemia?
Studies have shown that, in people with cancer, treating anemia can help:
- Relieve fatigue.
- Make everyday activities easier.
- Reduce the need for blood transfusions.
- Improve the quality of life.
- Make it more likely they will be able to complete their cancer therapy.
Myeloma and some of its treatments can affect the normal production of antibodies and reduce the white blood cell count, making it harder for the body to fight off infections.
|How does a low white blood cell count affect you?||How is it managed?|
Increased susceptibility to infections
Longer time required to recover from infections or illnesses
The M-proteins produced by myeloma are cleared from the body by the kidneys. Over time, the elevated levels of abnormal M-proteins in the blood and urine can damage the kidneys.
|How does kidney damage affect you?||How is it managed?|
Severe kidney disease may require dialysis (infrequently)
High blood calcium
As bone is broken down, it releases calcium in the bloodstream. If the myeloma is causing a lot of bone damage, the levels of calcium in the blood can become excessively high – a condition known as hypercalcemia.
|How does high blood calcium affect you?||How is it managed?|
More frequent urination
Confusion (in extreme cases)
Other blood complications
Myeloma can result in other blood complications, although they are relatively rare. Potential blood complication include:
- Low platelet levels.
- Normal blood clotting is affected, which can lead to bruising or excessive bleeding.
- Increased risk of blood clots in the veins, associated with some medication.
- Known as deep vein thrombosis (DVT), a potentially dangerous condition.
- Blood-thinning medication can be prescribed to reduce the risk.
- Thicker-than-normal blood (i.e., hyperviscosity) resulting from a high M-protein level.
- Can affect blood flow to the skin, fingers, toes, nose, kidneys or brain.
Bone pain, nerve pain and neuropathy
There are three main causes of pain for myeloma patients.
The type of treatment you require will depend on the cause of the pain, the severity of symptoms and how you respond to different therapies.
|Main causes of pain in myeloma patients||How is pain managed?|
Pain medication dependency and addiction
Some myeloma patients are reluctant to take opioid medication for their pain, because they're concerned about the potential for addiction.
Most healthcare professionals agree that there is very little risk that someone with no history of dependency will develop a true addiction.
Don't hesitate to discuss any concerns you may have with your medical team, who can answer your questions and recommend pain relief options that are right for you.
Dental health is very important for myeloma patients.
Encourage your dentist to talk to your oncologist, to discuss any special precautions you may require, especially while you are receiving treatment.
|How does myeloma affect dental health?||How can potential risks be reduced?|
Increased risk of infection
Osteonecrosis of the jaw (ONJ)
Side effects of medication
In addition to their intended effects, all prescription medication have other effects that you may not want – i.e., side effects. Ask your healthcare team, particularly your pharmacist and your nurse-educator, about:
- The potential side effects of the medications you are prescribed.
- Which side effects you should report immediately.
- What you can do to relieve side effects you may experience.
|Common side effects of chemotherapy||How are they managed?|
Nausea and vomiting
Changes in the mouth
|Loss of appetite||
|Common side effects of corticosteroids (steroids) that are frequently used to treat myeloma|
Fluid retention and swelling
Increase in blood sugar
Indigestion or heartburn
Mood or emotional changes
Long-term use of high-dose steroids can result in:
Other potential side effects
Coping with "Roid Rage"
Dealing with a diagnosis of cancer is hard for you and your loved ones. The mood changes that can be brought on by steroids can make things even harder.
Be sure to explain to your loved ones how steroids can affect your mood and activity levels. Give them a "heads up" when you go on or off your medication.
Chances are they'll be more supportive and understanding (and won't take things too personally) if they know that sometimes "it's the 'roids talking"... not you!
40%... That's the percentage of cancer patients who experience depression or anxiety, according to some studies.
As you deal with your disease, there may be periods when you're feeling "blue" or "down." You may sometimes feel like you're no longer the person you used to be. The physical and mental changes that are occurring may take a toll on your self-esteem.
While these feelings are completely understandable considering what you're going through, it's important for you to reach out to a health professional if you experience five or more of the symptoms on the checklist below for more than two weeks.
|Symptoms (experienced for more than 2 weeks)|
|Feelings of sadness, anxiety, irritability, nervousness and/or guilt|
|Feelings of worthlessness or hopelessness|
|Changes in your usual sleep patterns (having trouble sleeping or sleeping more than usual)|
|Changes in your appetite (gaining or losing weight without trying)|
|Loss of interest in activities that you used to enjoy|
|Restlessness or slowed behaviour|
|Persistent or recurring headaches, digestive disorders or chronic pain|
|Difficulty concentrating, remembering or making decisions|
|Fatigue, loss of energy|
|Changes in work style or productivity|
Thoughts of suicide (if these occur, seek immediate professional help)
If the depression continues for a period of several weeks without relief, or interferes with your everyday life, you may need help.
Don't try to deal with this all by yourself. Talk to your doctor, nurse or counselor. Sometimes, just sharing your thoughts and feelings is enough. In other cases, medication can be helpful. No matter what, always remember that you're not alone.
Before considering alternative therapies...
...there's something you should know.
Many vitamins, supplements and herbal products can interact with your cancer medications.
NEVER take any vitamins, supplement or herbal therapy without first consulting your physician and/or your pharmacist.